Provider Demographics
NPI:1730515974
Name:CREEKMORE, HALEY ELLYCE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:HALEY
Middle Name:ELLYCE
Last Name:CREEKMORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 WILDWOOD AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-6014
Mailing Address - Country:US
Mailing Address - Phone:501-983-2199
Mailing Address - Fax:501-506-3138
Practice Address - Street 1:2402 WILDWOOD AVE STE 115
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:AR
Practice Address - Zip Code:72120-6014
Practice Address - Country:US
Practice Address - Phone:501-983-2199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR10096-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical